Unit 6 and Unit 7 Part 1 Flashcards
1
Q
influenza
A
acute viral infc in URT
2
Q
when does influenza increase
A
seasonal infc
3
Q
which types of influenza have inc prevelance
A
types A, B,C
4
Q
incubation period for influenza
A
1-4 days
5
Q
what strain of influenza usually causes epidemics
A
A
6
Q
who has inc risk for influenza
A
HCP
peds pts
geri pts
7
Q
why do HCP have inc risk for influenza
A
personally compromised rt repeat exposure
8
Q
why do peds pts have inc risk for influ
A
defenses arent fully established yet
9
Q
why do geri pts have inc risk for influ
A
dec defenses rt to age
10
Q
patho influenza
A
viral injury to epithelial cells in URT, inflm/tissue damage
11
Q
why may abx be perscribed in influ
A
prophylaxis ONLY, to dec risk of 2ndary infc rt compromised IR in pts w inc susceptibility
12
Q
2 complications assoc with influ
A
2ndary bact infc
bronchitis/pnumonia
13
Q
what are complications of influ rt to
A
movement of virus to LRT lt bronchial/alveolar damage
14
Q
mnfts
A
cough
fever
malaise
15
Q
characteristics of cough in influ
A
beneficial unless the URT is irritated, then it inc irritation/infc -> damage
16
Q
course of influenza
A
self limiting
17
Q
tx of influenza
A
prevent spread vaccine for prophylaxis symptomatic mgmt limit infc to urt antivirals??
18
Q
egs of antivirals
A
amantadine
rienza
19
Q
amantadine
A
1st gen antiviral that inhibits RNA coating of virus
20
Q
what strains is amantadine most effective against
A
A and B
21
Q
rienza
A
2nd gen antiviral that inhibits replication of virus, prevents virus rls from host
22
Q
pnuemonia
A
inflm of bronchioles and alveoli
23
Q
what forms does pnuemonia come in
A
infectous
non infectous
24
Q
what is pnuemonia classifed by
A
agent
location
25
et of pnuemonia
usually dt bact, or virus, fuingu
aspiration
inhalation of fumes
26
how does inflm occur in pnuemonia
agent enters RT and proceeds into lungs
27
why is it abn for an infectous agent to proceed into the lungs
pulmonary defense is impaired and cant filter out pathogens
28
what happens when there is inflm in the lungs in pnuemonia
pulm edema -> impaired gas exch -> Co2 build up -> systemic hypoxia
29
typical pnuemonai
bacterial pnuemonia that occurs where there is empty spaces
30
atypical pnuemonia
dt any other agent, virus? things proliferating using cells around tissues
31
lobar pnuemonia
lung inflm specific to an entire lobe
32
broncho pnuemonia
inflm throughout alveoli in entire lung
33
area of consolodation
area with solidification of 3 components
34
what 3 components make up areas of consolodation when solidified
exudate
inflm debris
inflm cells
35
how are areas of consolidation seen
on cxr
36
mnfts of pnuemonia
```
fever/chills
dyspnea rt dec gas exchnage
sputum
headace
chest pain
```
37
what mnft makes pnuemonia different the flu
chest pain
38
sputum
combination of mucous and exudate
39
dx for pnuemonia
hx, px
cxr
sputum c and s
40
why are sputum c and s's done in pnuemonia
to determine if abx are needed
41
tx of pnuemonia
abx with typical pnuemonia
| symptomatic mgmt
42
COPD
persistant inflm causing aw, vasculature and parenchyma inflm
43
what episodic problem is prominent in copd
acute, recurrent, chronic obstr of aw
44
what disorder are included in copd
chronic bronchitis
| emphysema
45
what may copd coexist with
aasthma
46
et/risks for copd
smoking (80-90%)
recurrent resp infc (not chronic)
aging
genetic def of alpha one antitrypsin
47
why does aging inc risk for copd
lt dec lung compliance rt age of aw and l/o elasticity
48
what does smoking do to mucous prod? what does it lead to
inc mucous in RT, lumenal obstr
49
how does smoking compromise the mucociliary blanket
destroys cilia that lines the RT
50
how does inc mucous in RT affect cilia
overwhelms them by mucous logging them
51
what does smoking do to the airway
inflames it
52
what effect does smoking produce? (mnft)
coughing
53
what does coughing do to the airway of the copd pt
inc damage to inflamed area
54
what structures of the RT does smoking destroy
aw
| alveoli wall
55
3 mechanisms of airflow in chronic bronchitis (CB)
hypertrophy of bronchial wall
inflm and mucous sec
damage to elastic tissue
56
hypertrophy of bronchial wall in CB
lt dec lumen size dt inc inflm
57
inflm and mucous sec in CB
lt up to 50 percent lumen obstr. dt inflm causing inc exudate and smoking lt inc mucous
58
damage to elastic tissue in CB
lt dec compliace, airway is no longer held open
59
what is CB dt
smoking, reccurent infc
60
where do changes in CB appear first
large aw
61
characteristics of affected large aw in CB
hypertrophy of submucousal glands rt inc gland workload
62
why do submucosal glands of inc workload in CB
dt inc sec of mucous dt smoking
63
where do changes appear second in CB
smaller airway
64
what changes occur in the smaller aw in CB
inc in goblet cells
65
what does inc/excess mucous in CB lt
impaired mucociliary defense
66
what happens when mucociliary defenses are compromised in CB
infc and bronchial wall inflm
67
why does aw collapse occur in the patho of CB
lumen obstr rt inflm leads to collapse caused by trapping of air in terminal aw. air slowly diffuses out into circulation lt collapse
68
what happens do alveolar ventilation in CB, why
decreases, dt air trapped in parts of lung
69
what happens when there is a V:P imbal
hypoxemia
70
hypoxemia
dec O2 in ABG
71
V in V:P
air moving in and out lungs
72
P in V:P
gaseous exchange
73
normal V:P
0.8
74
normal V
4L air in and out/min
75
normal P
5.5L blood thru PC /min
76
what is important to remember about VP ratio
it could be the same number even if V and P are smaller, abn numbers
77
what variable changes in CB
| why
V
| dt abn obstr. even though aw may collapse, its still a ventilation problem, not perfusion
78
dx CB
chronic cough (cant use coughing alone)
79
chronic cough
presence of cough for 3 consec mo for 2 years
80
main mfnt of CB
impaired resp fx
81
how is impaired resp evidenced by
hypoxemia
| hypercapnia
82
resp fx
composed of gas exch and ventilation
83
other mnfts of CB (7)
```
activity intol
inc mucous prod
sputum
dyspnea
wheezing w/o auscultation
wet crackles
inc expiratory length
```
84
what is dyspnea in CB dt
lumen obstr
85
what is wheezing dt in CB
thinning aw
86
why are wet crackles heard in auscultation in CB
air moving over and thru mucous
87
why is expiration length inc in CB
rt dec elastic recoil of lungs -> trouble compressing TC to exhale quickly
88
complication of CB
secondary bact infc rt mucous accum
89
emphysema
destr of alveolar tissue and capilarry beds
90
what are of lung has inc incidence for emphysema
terminal airway
91
what does emphysema lt
l/o compliance
92
compliance
ease of lung filling/emptying with inc difficulty breathing
93
what happens to distal airspace in alveoli in emphysema
increases dt loss of wall integerity
94
what causes enlarged distal airspaces in emphysema
alveolar merging
95
why is alveolar merging not beneficial
inc alveolar size -> inc SA -> dec surface for gas exchange
96
et emphysema
smoking (classic)
| genetic def of alpha1 antitrypsin (A1A)
97
fx of A1A
protease, ez inhibitor, allows break down of old protein in an organized and controlled fashion
98
what is A1A responsible for
regulating protein breakdown in lungs
99
what does smoking do to A1A in classic emphysema
inhibits it
100
what happens when a1a is inhibited
inflm and protein break down in lungs
101
what does cigarette smoke attract to the lungs
inflm cells
102
what do inflm cells bring to lungs
inc proteases
103
what do proteases do to the lungs
alveolar damage
104
how is smoking with classic emphysema a triple wammy in terms of patho and lung damage
inhibits inhibitor
increases inflm cells
inflm cells bring inc protease
105
why is ventilation impaired in emphysema
permanent distended air spaces
106
what VP variable does emphysema change
Both
107
why is WoB inc in emphysema
air is trapped in spaces between alveoli
108
what does trapped air result in
increased amount of dead space
109
dead space
areas not involved in gas exchange
110
why is ventilatory effort in emphysema increased
rt dec/compromised lung capacity
111
what 3 things mean increased work of breathing
nasal flaring
pursed lip breathing
accessory m use
112
why does the P variable change in emphysema
capillary walls are destroyed by proteases -> impaired perfusion
113
another name for air pocket inbetween alveoli
bleb
114
bullae
when a bleb inc in size and is visible bc it presses on plueral memb
115
what does smoking lt (fig flowcart)
attraction of inflm cells
| dec a1a activity
116
what is released when inflm cells are attracted (fig flowchart)
elastase
117
what inhibits the action of elastase (fig flowchart)
a1a
118
what causes destruction of elastic fibers in lungs (fig flowchart)
dec a1a dt smoking
inherited a1a def
inhibited elastase action
119
what does destruction of elastic fibers lead to in lungs (fig flowchart)
emphysema
120
2 types of emphysema
centraacinar
| panacinar
121
centriacinar emphysema
destruction is confied to terminal and respiratory bronchi.
122
alveoli condition in centriacinar emphysema
currently have little damange
123
which type of emphysema is most common
centraacinar
124
panacinar
damage to aw and peripheral alveoli
| inc severity
125
mfnts of emphysema
dyspnea
inc ventilatory effor
barrel chest
126
what makes something a barrel chest
when chests transverse diameter and anterioposterior diameter are equal (2:2)
127
what is a normal chest diamter ration
2:1 transverse to anterioposterior
128
dx for COPD
hx, px
labs
cxr
pulm fx tests
129
what do pulm fx tests measure
lung vol
130
tx for COPD
limit progression
lifestyle mod
vaccine
drugs
131
what lifestyle mods have to be made to tx copd
NO smoking
| avoid aw irritants
132
why do we encourage COPD pts to get vaccianted
for prophylaxis rt dec IR and inc susceptibility
133
what vaccinations should copd pts receive
flu q1 year
| pnuemonial q5year
134
first line drugs for COPD
short acting b receptor agonist
| anticholinergics
135
what happens if first line drugs arent working for COPD
add inhaled steroids
136
what do we do if a short acting b receptor agoinst isnt working COPD
long acting b receptor agonist
137
thcophyline (COPD)
bronchodilator with some anti inflm properties
138
how do beta receptors work
cause bronchodilation in bronchiols (smaller aw)
139
how do anticholinergics work
cause bronchodilation in larger aw (bronchi)
